SHA-Based Health Accounts in 13 OECD Countries: … · SHA-BASED HEALTH ACCOUNTS IN THIRTEEN OECD...

DELSA/ELSA/WD/HTP(2004)11

SHA-Based Health Accounts in 13 OECD Countries: Country Studies

Spain National Health Accounts 2001

Jorge Relaño Toledano

and María Luisa García Calatayud

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OECD HEALTH TECHNICAL PAPERS

Unclassified DELSA/ELSA/WD/HTP(2004)11 Organisation de Coopération et de Développement Economiques Organisation for Economic Co-operation and Development 14-Sep-2004 ________________________________________________________________________________________________________ English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS COMMITTEE

OECD HEALTH TECHNICAL PAPERS NO. 11 SHA-BASED HEALTH ACCOUNTS IN THIRTEEN OECD COUNTRIES COUNTRY STUDIES: SPAIN NATIONAL HEALTH ACCOUNTS 2001

Jorge Relaño Toledano and María Luisa García Calatayud

JT00169111 Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format

DE

LSA

/EL

SA/W

D/H

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(2004)11 U

nclassified

English text only


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DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS

OECD HEALTH TECHNICAL PAPERS This series is designed to make available to a wider readership methodological studies and statistical analysis presenting and interpreting new data sources, and empirical results and developments in methodology on measuring and assessing health care and health expenditure. The papers are generally available only in their original language – English or French – with a summary in the other. Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France.

The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD

Applications for permission to reproduce or translate all or part of this material should be made to:

Head of Publications Service

OECD 2, rue André-Pascal

75775 Paris, CEDEX 16 France

Copyright OECD 2004

Health Technical Papers are available at www.oecd.org/els/health/technicalpapers.


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ACKNOWLEDGEMENTS

The OECD Secretariat is grateful to Jorge Relaño Toledano and María Luisa García Calatayud for preparing this study.

OECD Health Working Paper No 16 and OECD Health Technical Papers 1-13, presenting the results from the implementation of the System of Health Accounts, were prepared under the co-ordination of Eva Orosz and David Morgan. The first drafts of the country studies were presented and commented on at the OECD Meeting of Experts in National Health Accounts in Paris, 27-28 October 2003. Comments on the second versions were provided by Manfred Huber and Peter Scherer, and secretarial support was provided by Victoria Braithwaite, Orla Kilcullen, Diane Lucas, Marianne Scarborough and Isabelle Vallard.


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TABLE OF CONTENTS

ACKNOWLEDGEMENTS............................................................................................................................ 3

FOREWORD.................................................................................................................................................. 5

AVANT-PROPOS.......................................................................................................................................... 6

INTRODUCTION .......................................................................................................................................... 7

Preliminary remarks .................................................................................................................................... 8 Summary data on health expenditure .......................................................................................................... 9 Current health expenditure by provider and financing agent (SHA Table 3) ........................................... 17 Current health expenditure by function and financing agents (SHA Table 4) .......................................... 18 Conclusions ............................................................................................................................................... 20

ANNEX 1: METHODOLOGY .................................................................................................................... 21

Public expenditure..................................................................................................................................... 21 Private expenditure.................................................................................................................................... 22 Current state of ICHA implementation ..................................................................................................... 24

ANNEX 2: TABLES .................................................................................................................................... 29

ANNEX 3: SPAIN 2001 SHA TABLES...................................................................................................... 34


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FOREWORD

1. A project aimed at presenting initial results from the implementation of the System of Health Accounts has been carried by the Health Policy Unit at the OECD and experts from thirteen member countries. The results are presented in the form of a comparative study (OECD Health Working Papers No. 16) and a set of OECD Health Technical Papers presenting individual country studies. This volume is the eleventh in this series, presenting the Spanish SHA-based health accounts.

2. In response to the pressing need for reliable and comparable statistics on health expenditure and financing, the OECD, in co-operation with experts from OECD member countries, developed the manual, A System of Health Accounts (SHA), releasing the initial 1.0 version in 2000. Since its publication, a wealth of experience has been accumulated in a number of OECD countries during the process of SHA implementation, and several national publications have already been issued. Furthermore, the Communiqué of Health Ministers, issued at the first meeting of OECD Health Ministers held on May 13-14, 2004 emphasised the implementation of the System of Health Accounts in member countries as a key item in the future OECD work programme on health.

3. The Secretariat considers as a key task to disseminate the SHA-based health accounts of OECD member countries and their comparative analysis. In the series of Health Technical Papers - that are also available via the internet - the key results are presented on a country-by-country basis, supported by detailed methodological documentation. They – together with the comparative study - will provide a unique source of health expenditure data with interpretation of SHA-based health accounts. In particular, the results describe in a systematic and comparable way that how, and for what purposes, money is spent in the health systems of the participating countries. These papers are also important in a methodological sense: the analysis of data availability and comparability shows where further harmonisation of national classifications with the International Classification for Health Accounts (SHA-ICHA) would be desirable.

4. Thirteen countries participated in this project: Australia, Canada, Denmark, Germany, Hungary, Japan, Korea, Mexico, the Netherlands, Poland, Spain, Switzerland and Turkey. The next edition of the comparative study to be published in 2006, is expected to include several additional countries. Meanwhile, new country studies will be presented on the OECD SHA web page and in the Health Technical Papers when they become available.

5. The OECD Secretariat invites readers to comment on the series of Health Technical Papers on SHA-based health accounts and to make suggestions on possible improvements to the contents and presentation for future editions.


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AVANT-PROPOS

6. L’Unité des politiques de santé de l’OCDE et des experts originaires de treize pays Membres ont mené un projet visant à rendre compte des premiers résultats de la mise en œuvre du Système de comptes de la santé (SCS). Ces résultats se présentent sous la forme d’une étude comparative (document de travail sur la santé n° 16 de l’OCDE) et d’un ensemble de rapports techniques sur la santé contenant des études par pays. Ce volume est le onzième de la série, il examine les comptes de la santé fondés sur le SCS en Espagne.

7. Face à la nécessité croissance de disposer de statistiques fiables et comparables sur les dépenses et le financement des systèmes de santé, l’OCDE, en collaboration avec des experts des pays Membres, a élaboré un manuel intitulé Système des comptes de la santé (SCS), dont la version 1.0 a été publiée en 2000. Depuis sa publication, une grande expérience a été accumulée dans plusieurs pays de l’OCDE au cours du processus d’application du SCS, et plusieurs publications nationales sont déjà parues dans ce domaine. En outre, le Communiqué des ministres de la santé, diffusé lors de la première réunion des ministres de la santé de l’OCDE qui s’est tenue les 13 et 14 mai 2004, qualifie l’application du Système des comptes de la santé dans plusieurs pays Membres d’élément clé du futur programme de travail de l’OCDE sur la santé.

8. Le Secrétariat juge essentiel de diffuser les comptes de la santé fondés sur le SCS des pays Membres de l’OCDE ainsi que leur analyse comparative. Dans la série des rapports techniques sur la santé, également disponibles sur internet, les principaux résultats sont présentés pays par pays et s’accompagnent de documents détaillés sur la méthodologie employée. Ces rapports, conjugués à l’étude comparative, constituent une source unique de données sur les dépenses de santé et fournissent une interprétation des comptes de la santé fondés sur le SCS. Ils décrivent en particulier de manière systématique et comparable la façon dont les dépenses de santé des pays participants s’effectuent ainsi que leur objet. Ces documents sont également importants d’un point de vue méthodologique : l’analyse de la disponibilité et de la comparabilité des données révèle les domaines dans lesquels il serait souhaitable de poursuivre l’harmonisation des systèmes de classification nationaux avec la classification internationale pour les comptes de la santé (ICHA).

9. Treize pays ont participé à ce projet : l’Allemagne, l’Australie, le Canada, la Corée, le Danemark, l’Espagne, la Hongrie, le Japon, le Mexique, les Pays-Bas, la Pologne, la Suisse et la Turquie. La prochaine version de l’étude comparative, à paraître en 2006, devrait inclure plusieurs pays supplémentaires. Pendant ce temps, de nouvelles études par pays seront présentées sur la page web du SCS de l’OCDE et dans les rapports techniques sur la santé dès qu’elles seront disponibles.

10. Le Secrétariat de l’OCDE invite les lecteurs à faire part de leurs commentaires sur la série des rapports techniques sur la santé relatifs aux comptes de la santé fondés sur le SCS, ainsi que de leurs suggestions sur la façon dont le contenu et la présentation des prochaines éditions pourraient être améliorés.


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INTRODUCTION

11. It has been a priority for the Ministry of Health and Consumer Affairs to produce and make available to politicians, academics and the public alike, information and data concerning expenditure on health. Such information allows each of them to know how the economic resources have been employed in order to achieve the health services that both society demands, and that the constitution grants.

12. The necessary information should be gathered and produced within the framework of an accounting system that makes it easy to draw comparisons and to reach conclusions in a homogenous and international context. The accounting system used in Spain to produce health expenditure accounts is based on the Satellite Accounts Methodology (Estadística del Gasto Sanitario Público -EGSP) as far as public expenditure is concerned, and on National Accounts and Hospital statistics for the private sector.

13. Initially, the EGSP referred to a highly centralised health system, in which the former INSALUD (National Institute of Health) held responsibility for the provision of health services to a decreasing, although still important, proportion of the Spanish population. This meant that a significant part of the data came from a single information source, therefore guaranteeing their consistency and comparability. Funding was also centralised, meaning that the economic resources employed in health services flowed mainly from state funds, even if a complex path is taken in order to reach the ultimate provider.

14. However, from 2001, changes occurred both in the structure and operating procedures of the National Health System, bringing about new circumstances in which to develop health expenditure statistics. The year marked the end of the devolution process, which meant that all of the 17 Autonomous Communities had complete freedom to manage their own health services. Health funding was integrated within the general financing system through tax cession; the Communities could spend on health services according to their tax collection capacity, albeit in compliance with a minimum expenditure, as specified in the regulations currently in force.

15. Therefore the collection of data in order to produce health statistics – both economic and medical - needed a new approach. The Cohesion and Quality of the National Health System Act (Ley de Cohesión y Calidad del Sistema Nacional de Salud, 28/05/2003) took on this task. It established a new System of Health Information in order to ensure the availability of information as well as the communication and comparability of data from the different Autonomous Communities.

16. Within this context, the SHA Manual provides a framework of comparability and coherence in which to develop health expenditure statistics. The EGSP, as satellite accounts, remains a necessity, although its development must go in parallel with the implementation of SHA.

17. This study regarding the implementation of the SHA in Spain provides the first data of Spanish health care expenditure according to the three SHA classifications: functional, providers and financing agents. These data should be considered as preliminary, requiring refinement, although the work undertaken has been very useful in order to integrate the different and various data sources available and adapt them to the SHA framework.


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18. In this context, under the Ministry of Health and Consumers, experts from the different Autonomous Communities have been consulted, and a working group has been established to study the SHA implementation in Spain. We hope this paper becomes a useful and stimulating step to encourage the further development of these studies.

Preliminary remarks

19. The work undertaken in order to present the figures of Spanish Health Care Expenditure according to the SHA framework has focused on two issues:

• Adapting the previous classifications and tables from the Spanish Statistics of Public Health Care Expenditure (EGSP)

• Introducing private expenditure into the new reporting framework.

20. The total expenditure figures appearing in this report are the same as those sent to OECD to be included on OECD Health Data 2003, based on EGSP and National Accounts. Later, small changes have been made, so figures included in the next edition of the EGSP will differ slightly.

21. Neither new functions nor providers have been included, so the departures from OECD/SHA boundaries and classifications remain as highlighted in OECD Health Data 2003:

• Health care expenditure (HCE) does not include health care provided in nursing and residential premises for elderly and disabled people. It only includes long-term care provided by hospitals for this specific purpose according to the Spanish hospital statistics.

• Health expenditure incurred by industries in their production process (occupational health care) is not included.

• Private investment in medical facilities only includes hospital capital expenditure.

• Prevention and public health expenditure only covers public expenditure.

22. There are slight differences between the figures of the Spanish public health accounts and those reported for OECD Health Data and within this study regarding current health care expenditure. This results from the inclusion in the national accounts of some health related functions as current expenditure in collective services (i.e. Expenditure on research and development and expenditure on personnel training).

23. The main objective of this paper is not to give definitive and entirely accurate figures for the different SHA classifications, but to review and integrate the different and various data sources available in order to adapt them to the SHA framework. It will also explain how estimates have needed to be made, taking into account the fact that the main data sources are based on budgetary documents of expenditure agents. This means that it is necessary to move from a budgetary accounting system to another focussing on activities based on the modes of production (MOP).

24. Some indicators used to reach MOP estimates were available only for 1999 which have then been applied for the period 1999-2001. This means that cost structure data remains constant.

25. We must point out that budgetary and cost accounting information from INSALUD has been essential in order to have a representative sample that allows us to estimate the expenditure structure of the


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National Health System. From 2002, once health services from INSALUD have been devolved to the Autonomous Communities, it would be necessary to improve the health information system to get homogeneous information to fill the information gap.

26. Consequently, it will be necessary to have a substantial agreement with the AACC regarding a new approach to the recording of economic information, according to SHA classifications

27. It is hoped that in the future we would be able to widen our expenditure borderlines to include those services now excluded from our health expenditure statistics.

28. This is especially required for LTC expenditure incurred in nursing and residential care facilities and rehabilitative centres that depend on the Ministry of Labour and Social Affairs or on the Autonomous Communities’ Councils of Social Services. Social matters have, in many cases, been transferred to the Autonomous Communities (AACC) before Health Care management. LTC is also an important matter carried out by the Local Authorities through their Social Service programs.

Summary data on health expenditure

Health expenditure by financing source

29. Over the period 1999-2001, per capita total health expenditure increased from 1 057.4 euros to 1 194.4. In 1999, 763.2 euros per capita were spent by the public sector and 294.3 by the private. In 2001, these amounts were 854.2 and 340.2 respectively.

30. In terms of constant prices (1995 GDP level) per capita total expenditure was 948.8 euros in 1999 and 994.3 in 2001. The corresponding figures for public expenditure were 648.8 and 711.2 euros, while private expenditure was 264.1 in 1999 and 283.1 in 2001.

31. As a share of GDP, total expenditure amounted to around 7.5%. The private expenditure share was 2.1 %, and public 5.4 %.

32. Public health care expenditure has kept its share of GDP as a result of the Health Care Financing Models (1994-1997 and 1998-2001) set up by Central government and the AACC. These models linked the evolution of the public funding of Health Care with the growth of the Spanish economy, specifically with the increments of GDP. This funding, covering more than 80 % of public health care expenditure, was allocated in the General State Budget under the Health function, and under the responsibility of the Ministry of Health. It was mainly allocated to the AACC on a per capita basis.

33. The health care financing model in force during the period 1998-2001 also envisaged some measures to encourage saving, specifically in the fields of pharmaceutical expenditure and temporary disability control, which resulted in a more efficient allocation of Public resources for health care financing.

34. Consequently, the year-on-year variations of public health care expenditure were roughly the same as GDP, whereas private expenditure grew faster than GDP, public expenditure and total expenditure. Table 1 shows the overall increase and the year-on-year variations for the period 1999-2001 in real terms (1995 GDP price level).


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Table 1. Growth rates of Health Care Expenditure and GDP at constant 1995 GDP price level

Public sector Private sector Total GDP

2001/1998 10.83 15.02 11.99 11.70 1996/1995 2.85 1.94 2.60 2.44

1997/1996 2.26 1.75 2.12 4.03

1998/1997 3.98 5.35 4.36 4.35

1999/1998 4.34 4.88 4.49 4.22

2000/1999 2.91 5.09 3.51 4.21

2001/2000 3.22 4.35 3.54 2.84

35. For the reasons stated above, the private sector increased its share of total health care expenditure, in terms of current expenditure, from 28.26% in 1999 to 29.09% in 2001 (Table 2). Therefore, the public share was 71.74 % and 70.91 % for the corresponding years.

Table 2. Spain 1999 - 2001 Current Health Care Expenditure by Financing

% Millions of current Euros

Public sector Private sector Public sector Private sector Total

1998 71.91 28.09 27,556 10,765 38,321

1999 71.74 28.26 29,521 11,628 41,149

2000 71.29 28.71 31,437 12,662 44,099

2001 70.91 29.09 33,616 13,793 47,408

36. The different sources of health care funding have kept quite stable their participation over the period 1999-2001. In 1999, the major sectors funding health care expenditure were Central government, accounting for 58.8% of the total, and Householders accounting for 22.6%. In 2001, the figures were 58.4% and 23.6 % respectively (Figure 1 and Table A1).

37. For 2001, the AACC funded 6.1%, the Social Security System 3.6%, Public Servants Insurance 3% and Private Health Insurance 4%. Finally, Local Authorities and Non Profit both contributed less than 1% of the total funding.


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Figure 1: Total health expenditure by financing agent (Total health expenditure = 100)Spain, 2001

Social security, 6.6

General government (excl. social security), 65.0

NPISHs, 0.9

Out-of-pocket payments, 23.6

Private insurance, 4.0

Public financing

Private financing

Figure 2: Total health expenditure by function (Total health expenditure = 100)Spain

Health admin. and insurance, 2.3

Gross capital formation, 3.2

Curative and rehabilitative care, 62.8

Long-term nursing care, 2.1Ancillary services, 3.2

Medical goods, 25.0

Prevention and public health, 1.4

Personal medical services

Collective services

Gross capital formation

Medical goods

Public 44.7Private 18.1



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Figure 3: Current health expenditure by mode of production (Current health expenditure = 100)Spain, 2001

Out-patient care, 36.4

Day-care, 0.9

In-patient care, 29.3


Prevention and public health, 1.4

Home care, 0.4

Ancillary services, 3.4

Medical goods, 25.8Personal medical services

Medical goods

Collective services

Public (HF.1) 20.9Private (HF.2) 15.5



Figure 4: Current health expenditure by provider (Current health expenditure = 100)Spain


Providers of public health programmes, 0.9

All other industries, 0.3

Hospitals, 42.3

Providers of ambulatory care, 28.3

Retail of medical goods, 25.6





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38. It should be pointed out that, from 1994 to 2001, the National Institute of Health (INSALUD) was the Social Security Institution in charge of delivering the Public Health Care for around 40% of the Spanish population. However, from 1999 this care was completely financed through General Government funds and social contributions were no longer a financial resource for this institution.

39. Only the activities of the Social Institute of the Navy (Fishing and Merchant Navy) and the Mutual Insurance of Industrial Accidents and Occupational Disease are presently funded through Social Security funds.

Health expenditure by function

40. The expenditure on Gross capital formation regularly accounts for around 3% of total health care expenditure. However, it should be noted that, as far as the private sector is concerned, this expenditure is underestimated as the data only includes expenditure incurred by private hospitals. A reliable source of information in relation to outpatient care providers does not exist in Spain.

41. Analysing the one-digit level functions, it appears that Current expenditure on personal health care (HC1-HC5) accounts for around 96 % of total current expenditure, whereas collective services’ share is almost 4 % (Figure 2 and Table A2).

42. In 2001, Medical services (HC1-HC4) accounted for 70.4 %, medical goods for 25.8%, and only 3.3% was spent on ancillary services to outpatients.


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43. The share of curative and rehabilitative care is slowly decreasing (65.6% of current expenditure in 1999, 65.3% and 64.9% in 2000 and 2001). However, this may be overestimated to some extent, because of the weakness of the private expenditure sources of information.

• The source of information for private health care expenditure is National Accounts, classified according to the COICOP classification of Final Household Consumption Expenditure. The lack of a detailed breakdown of this classification and, specifically, the item 6.2 – Outpatient services- forces us to include in HC.1.3 function, not only curative services, but also some rehabilitative care and ancillary services. That is also the reason we are not able to reach the three digits level of ICHA-HC and identify Outpatient dental care.

44. All other functions are increasing their shares.

Current health expenditure by mode of production

45. Of the total expenditure on personal health care services (HC1-HC4), outpatient care accounts for 52% and inpatient care accounts for 42 %. The expenditure on Outpatient care is increasing while Inpatient care spending is falling (Figure 3 and Table A3).

46. Day cases and Home care services are residual amounts. They respectively account for 1.3% and 0.6 % of expenditure on Personal health care services. Ancillary services accounts for the remaining 4.8%.

47. The appreciable trend of Day cases and Home care decreasing, suggests that these services, which have minimal expenditure, are losing importance in the hospital sector, which is contrary to the generally admitted idea of how Spanish hospitals are organising their activities.

48. This trend could be due to the use, in the allocation of hospital costs, of static indicators referring to the year 1999.The availability of more accurate or current indicators should, probably, result in a higher importance of these services.


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Figure 5. Spain 2001 Personal health care services by MoP and financing source

41.5949.98

19.08

80.92

4.76

1.32

1.82

40.8451.72

0.61 0.84

6.53

0%

20%

40%

60%

80%

100%

Total expenditure Public sector Private sector

Ancillary services

Home care services

Out-patient services

Day care services

In-patient services

49. As far as the distribution of personal health care services by mode of production is concerned, there is a significant difference in the composition of private and public expenditure. Inpatient services play a very important role in the public sector, 50% of total public personal health care services, while private inpatient accounts for only 19.1%. Consequently, outpatient services account for 80.9 % of the total personal health care services in the private sector making it the core mode of production (Figure 5).

50. Day care and home care services do not record any expenditure for the private sector, due to the lack of statistical sources.

Current health expenditure by provider

51. There is a stable structure among Spanish health care providers, divided into three main blocks (Figure 4 and Table A4)

• Hospitals, with around 43 % of the current health care expenditure and a slight decreasing trend.

• Outpatient care providers, around 28 % and an increasing trend.

• Pharmacies and other providers of medical goods, around 25 % and an increasing trend.

52. Providers of collective services accounted for 3.2% in 1999 and 3.5% in 2001. They show the greatest relative increases, perhaps because, over this period, the still not devolved AACC were adapting their administrative services and information systems to the impending devolution process.


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Figure 6. Spain 1999-2001 Current Health Care Expenditure by Provider

43.1 42.7 42.3

14.8 15.0 15.0

13.27 13.18 13.24

21.84 21.66 21.90

3.33 3.49 3.66 0.860.920.73

2.622.612.46

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1999 2000 2001

General healthadministration andinsuranceProvision andadministration of publichealth programmesOther providers ofmedical goods

Pharmacies

Other out-patientproviders

Offices of phisicians

Hospitals

53. The providers' structure remains stable if we consider a more desegregated classification. It is interesting to point out that we can identify some providers that are overwhelmingly private providers and others that are almost exclusively public ones (Figure 6).

54. Offices of physicians (HP.3.1) and Other providers of medical goods (HP.4.2-4.9) provide services and goods mostly for the private sector. Health Centres are the public units providing Primary Care, accounting for the 80 % of total expenditure included as Other outpatient providers (HP.3.3-3.9). Collective services’ providers and Other sectors such as secondary producers of health care, are either public providers or their services are mainly paid for by the public sector.

55. Nevertheless, this structure of expenditure by providers is problematic, as far as private expenditure is concerned, because of the data sources used:

• From the providers’ viewpoint, dentist services are included in HP 3.1. The desegregation of the COICOP item 6.2, if possible, would produce a significant difference in the providers’ classification. This will affect the private expenditure classifications. The public classifications are not affected since the public Spanish Health System covers preventive dental care for children as part of the primary care and does not generally include dental curative care as a benefit.

• Moreover, the definitions of items 6.2 and 6.3 of COICOP imply that outpatient services provided by private Hospitals are also included in COICOP 6.2. A first estimate of these services has been done to assign them to private hospitals as providers.


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Current health expenditure by provider and financing agent (SHA Table 3)

56. The health financing system in force in Spain until 2001 produced many financing flows across the different institutional units involved in the public health care expenditure (Central Government, Social Security System, Regional Governments, etc.)

57. Most of the public expenditure on health (82 %) was consigned in the General State Budget under the responsibility of the Ministry of Health. This money was then transferred to INSALUD, which was responsible for managing health care institutions in ten regions (AACC). INSALUD also acted as a distributor and, in this role, transferred funds to the seven AACC where health matters had been devolved. The regional governments received these funds and transferred it on to the Regional Health Services.

58. This makes it impossible to separate funding by functions. Money flows through those agents, without being functionally predetermined or for an earmarked provider. Only at the last agent level, the one who incurs the expenditure, a functional distribution becomes possible.

59. To sum up, as far as the period 1999-2001 is concerned, we can offer a functions/providers breakdown of the public expenditure, not of the public funding.

60. From 2002 onward the situation has dramatically changed. Coinciding with the end of the devolution process of Health Care, a new model of autonomous general funding has been set up. Health care is not longer financed in a different way than other devolved powers. Financing resources come from a higher degree of fiscal co-responsibility of the AACC, by means of giving them the power to manage part of the tax collection from the general Income Tax and VAT, plus the total tax collection of some specific taxes on alcoholic drinks, hydrocarbon consumption and others.

61. Consequently, after 2002, a meaningful cross-classification of the health care expenditure by providers/functions and financing agents will be possible for most of the expenditure, according to the ICHA-HF classification.

62. Therefore, at present, the analysis of how the functions and providers are financed is only possible by comparing public and private sectors at an aggregated level.


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Figure 7. Spain 2001 Current Expenditure by provider and financing source

42.32

52.50

17.49

48.22

20.66

0.4211.55

15.031.41

18.6713.24

21.9022.41

3.66

2.84 2.082.62

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Total Expenditure Public sector Private sector

General healthadministration andinsurance

Provision andadministration of publichealth programmes

Other providers of medicalgoods

Pharmacies

All other out-patientproviders

Offices of phisicians

Hospitals

63. Regarding the total current expenditure, the different structure of providers between the public and the private sectors is remarkable (Figure 7).

64. In the public sector, Hospitals are the major providers, accounting for more than 50% of the total current expenditure, whereas in the private sector 48.2% of the expenditure goes to the Offices of physicians. Even taking into account the already mentioned overvaluation of this provider, we can state that the Offices of physicians and/or dentists provide almost a half of private personal health care services.

65. The share of Pharmacies is almost the same in both sectors, around 20 % of the total current expenditure, but the share of Other providers of medical goods is much bigger in the private expenditure. This is because the public Spanish Health System does not cover expenditure on glasses and hearing aids, which is a significant amount of the Households’ expenditure on health.

Current health expenditure by function and financing agents (SHA Table 4)

How the different functions are financed (SHA Table 4.2)

66. Collective services of health care are hardly provided by the private sector. Only the insurance services connected with health are included. This accounts for 0.5 % of current health care expenditure. Personal health care services amount to around 70 % of personal health care services and goods (HC1-HC5) in both public and private sectors, but the distribution between Inpatient and Outpatient care is quite different between the sectors.


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Figure 8. Current expenditure on personal services and goods by function and financing source

28.2235.18

11.66

37.8430.92

54.30

1.143.48 4.95

23.0323.84

21.10

3.80 0.4411.80

2.692.23

1.991.40

0%

20%

40%

60%

80%

100%

Total expenditure Public sector Private sector

Therapeuticappliances andother durablesPharceuticals andther non durables

Ancillary services

Other personalservices

Long term care

Out-patientcurative &rehab.careIn-patient curative& rehab.care

67. Both of these MOP have roughly the same share of the functions HC1-HC5 in the public sector (30% outpatient care and 35% inpatient). However, in the private sector, outpatient care is five times that of the inpatient one (54.3 % against 11.7 %) (Figure 8).

68. Two reasons could explain this difference:

• The features of the Spanish Health System, which does not cover curative dental care.

• The methodological issue concerning the desegregation of COICOP item 6.2

69. The share of Pharmaceuticals is 23.8% in the public sector, against 21.1% in the private sector. For therapeutic appliances the shares are 0.4% and 11.8% respectively. The reason of this difference lies, as in the case of the Offices of dentists, in the lack of public cover for Households’ expenditure on glasses and hearing aids.

70. Comparable figures for public and private expenditure on medical appliances are not available. This is due to the lack of desegregation of the National Accounts figures of the COICOP item 6.1 Medical products. Even reaching the three-digit level of COICOP, item 6.1.3 -Therapeutic appliances- would include glasses and many other medical and orthopaedic goods besides.


20

Conclusions

71. Some conclusions can be drawn from this study on the Spanish Health Care System regarding its structure, volume and methods of accounting in order to adapt them to the SHA framework.

72. A remarkable characteristic is the different structure of the public and private sectors. In the public sector there is a rough equilibrium between inpatient and outpatient modes of production. On the other side, the private sector, outpatient mode of production is widely preponderant. Consequently the weight of hospitals in private health care activities and expenditure is only a third of the offices of physicians, whereas the public sector has the contrary proportion: the weight of hospital is three times that of outpatient providers.

73. As stated above, private outpatient curative care includes not only curative care, but also some ancillary and rehabilitative services. However, the major explanation of this different structure lies in the fact that dental curative services are not covered by the public sector. This kind of care is reported under the provider “offices of physicians” and explains the great presence of this provider in the private sector.

74. As far as methodological issues are concerned, some steps have to be taken to reach an appropriate reporting of the Spanish health care expenditure under the SHA frame.

• To expand the boundaries of the expenditure reported by means of including health care provided by social services institutions as well as the occupational health provided in private enterprises.

• To improve the estimation methods based on cost accounting in the health care centres. In this sense, agreements with the Autonomous Communities are needed on how to assign cost to the modes of production. It is necessary to reach a more accurate breakdown of the functions.

• To go deeper in the classification of private expenditure in order to fix the distribution of this expenditure by functions and providers.


21

ANNEX 1: METHODOLOGY

Public expenditure

Public health expenditure statistics. Cuentas Satélite del Gasto Sanitario Público (EGSP) 1960-2001. Ministerio de Sanidad y Consumo. 75. Provides total public figures by functions. To start with there is a strong correspondence between EGSP functions and the first SHA functional level. Also, it gives initial and partial information about MOP outpatient curative care services: i.e. those services offered by Health Centres as providers.

76. The EGSP’s most important limitation is the impossibility of desegregating hospital expenditure, not only by functions (curative, rehabilitative, ancillary services) but also by MOP (inpatient, day care, outpatient, home care).

77. The main difficulty in order to delineate the modes of production lies in the fact that specialised units (Specialities Centres) are attached financially to hospitals. These units act as intermediaries between Primary and Hospital services, but hospital budgets - the main EGSP information source- do not separately account their expenditure. Furthermore, it is not possible to identify external consultations in hospitals.

Hospital statistics. Estadística de Establecimientos Sanitarios con Régimen de Internado (ESRI). Ministerio de Sanidad y Consumo (1998 - 2000) 78. The ESRI supplies hospital expenditure data by acute care and long term care hospitals - both private and public. As the classification is based on the purpose of the hospitals, it is not possible to have information about long-term care services provided by hospitals not labelled as long term care institutions, although this is estimated to be minimal. As said under the general remarks, data is not available for health expenditure incurred by providers other than hospitals: i.e. nursing and residential premises for elderly people dependent on the Labour and Social affairs.

79. The ESRI permits, as well, to classify the different hospital providers : long term care, psychiatric and acute care.

The National Health System Reference Costs. Ministerio de Sanidad y Consumo. 1999 80. Gives cost information from a sample of 18 public hospitals in order to identify inpatient activity costs and allocate them to the different hospital DRG. Under this process the activities excluded from the hospital costs are the same as those that SHA exclude from inpatient curative care: i.e. day cases curative care (ambulatory surgery, dialysis, oncological day care), external consultations, diagnostic specialised services, services of curative home care. Only the postgraduate resident training received a different approach, since these costs have been included as inpatient expenditure.

81. According to this, we have estimated that 64.03% of the cost of acute care hospitals refers to inpatient activity, and the other 35.97% must be allocated to outpatient hospital activities; similarly, the National Health System Reference Costs provides the structure, in percentage terms, of the different outpatient activities.


22

Clinical-Financial Management and cost per process. Gestión Clínico – Financiera y coste por proceso (GECLIF). INSALUD. 2000 82. The GECLIF is a cost accounting tool introduced into the INSALUD hospitals. It gives economic indicators about inpatient and outpatient activities with reference to both the final cost centres and high cost intermediate ones. It also provides the average cost per process.

83. GECLIF indicators have been used to estimate the expenditure of services of rehabilitation (considered as a final cost centre), and those of laboratory and diagnostic imaging (intermediate costs centres). GECLIF indicators have also been used to check the inpatient activity / outpatient activity ratio obtained with the National Health System Reference Costs.

Private expenditure

84. Private expenditure figures come from the addition of the following:

• Household final consumption expenditure on health

• Household final consumption expenditure on insurance services connected with health

• NPISH final consumption expenditure on health

• Hospital capital expenditure

85. The ESRI (source number 2) has also been used according to the same terms and limitations as used for public expenditure. It also provides private capital expenditure.

National Accounts : Household Final Consumption expenditure. SG de Cuentas Nacionales. INE 86. ESA 1995 provides a new concept that makes it easier to estimate private expenditure: Household final consumption expenditure gives an expenditure magnitude rather than a consumption one, as under the previous system. Therefore it is not necessary to adjust the social benefits in kind.

87. It gives expenditure according to the COICOP (two-digit level): 6.1 Medical products, appliances and equipment 6.2 outpatient services 6.3 Hospital services, and COICOP (three digit level): 12.5.3 - Insurance services connected with health.

88. However this classification is insufficient for SHA requirements, so the desegregation in private expenditure could not attain the same level as the public one. Some adjustment has been made to eliminate some public financed expenditure in order to avoid double accounting.

NPISH final consumption expenditure on health. SG de Cuentas Nacionales. INE 89. Input-output framework provides total figures on NPISH final consumption expenditure on health. The Hospital Statistics (ESRI) help to classify them by functions.

Household Budget Continuous Survey(HBCS) Encuesta de Presupuestos Familiares (EPF. INE) 90. The HBCS provides information on the way households used their incomes in several consumption expenditures. It offers the COICOP classification, with a three-digit level of desegregation. This level offers us the possibility to produce expenditure estimates in SHA terms. But the expenditure


23

figures that HBCS gives differ considerably from the National Accounts ones, not only in absolute value but also in the distribution among the expenditure concepts.

91. With that premise, the use of the HBCS expenditure structure to estimate the breakdown of the two-digit level figures from CN Household final consumption expenditure becomes a very problematic matter. So far, it is only used in the desegregation of item 6.1 of COICOP -Medical products, appliances and equipment, in which the variation between the two sources is not as significant as in the other items.

Indicators of the pharmaceutical benefit (IPB). INSALUD. 1999-2001 92. The IPB allows the calculation of the householders’ co-payment for prescribed medicines.


24

Current state of ICHA implementation

Health Expenditure by Financing

ICHA SHA Manual Categories used in national practice and / or departures from the ICHA as to the content of the category

HF.1 General government

HF.1.1 General government excluding social security funds

For the period 1999-2001, General Government financed around 80% of Public health expenditure. See Table 1

HF.1.1.1 Central government

HF.1.1.2 State/provincial government

HF.1.1.3 Local/municipal government

HF.1.2 Social security funds

From 1994 to 2001, INSALUD was the Social Security Institution in charge of the Health Care for around 40% of Spanish population. Nevertheless, from 1999 this care was funded trough General Government funds. Only the activities of the Social Institute of (Civil) Navy and the Friendly Societies of Industrial Accidents and Occupational Disease are, currently, funded from Social Security funds.

HF.2 Private sector

HF.2.1 Private social insurance

HF.2.2 Private insurance enterprises (other than social insurance)

HF.2.3 Private household out-of-pocket expenditure

HF.2.3.1 Out-of-pocket excluding cost-sharing

HF.2.3.2 Cost-sharing: central government Only exists for prescribed medicines.

HF.2.3.3 Cost-sharing: state/provincial government

HF.2.3.4 Cost-sharing: local/municipal government

HF.2.3.5 Cost-sharing: social security funds

HF.2.3.6 Cost-sharing: private social insurance

HF.2.3.7 Cost-sharing: other private insurance

HF.2.3.9 All other cost-sharing

HF.2.4 Non-profit institutions serving households (other than social insurance)

HF.2.5 Corporations (other than health insurance)

HF.3 Rest of the world


25

Health Expenditure by Function


HC.1 Services of curative care

HC.1.1 Inpatient curative care For private expenditure it is not possible to separate from inpatient services (COICOP 6.3). It is not possible to separate Long Tem care provided by General Hospitals.

HC.1.2 Day cases of curative care Includes the so-called "Day Hospital" units in General Hospitals plus outpatient contracted Dialysis Services.

HC.1.3 Outpatient curative care For private expenditure it is not possible to separate from outpatient services (COICOP 6.2.) Therefore, includes rehabilitative care and ancillary services.

HC.1.3.1 Basic medical and diagnostic services

HC.1.3.2 Outpatient dental care Only Civil Servants Insurance provides this kind of care in the public sector. As for private expenditure it is not possible to separate from outpatient services (COICOP 6.2.)

HC.1.3.3 All other specialised health care

HC.1.3.9 All other outpatient curative care

HC.1.4 Services of curative home care

HC.2 Services of rehabilitative care Includes, as Speciality Hospital, the National Centre of Paraplegics Rehabilitation, which activity it is not possible to separate by mode of production.

HC.2.1 Inpatient rehabilitative care

HC.2.2 Day cases of rehabilitative care

HC.2.3 Outpatient rehabilitative care Includes General Hospitals, Health Centres and contracted physiotherapy.

HC.2.4 Services of rehabilitative home care

HC.3 Services of long-term nursing care Includes Long-stay Hospitals and Psychiatric Hospitals. For Psychiatric it is not possible to separate by mode of production. Nursing and residential care facilities are not included as providers.

HC.3.1 Inpatient long-term nursing care

HC.3.2 Day cases of long-term nursing care

HC.3.3 Long-term nursing care: home care

HC.4 Ancillary services to health care

HC.4.1 Clinical laboratory Estimated for public General Hospitals, plus contracted outpatient services.

HC.4.2 Diagnostic imaging Estimated for public General Hospitals, plus contracted outpatient diagnostic imaging.

HC.4.3 Patient transport and emergency rescue Includes Services of Urgent Transport (“061” Service) that depend on the Primary Care Services.

HC.4.9 All other miscellaneous ancillary services

HC.5 Medical goods dispensed to outpatients

HC.5.1 Pharmaceuticals and other medical non-durables

HC.5.1.1 Prescribed medicines

HC.5.1.2 Over-the-counter medicines

HC.5.1.3 Other medical non-durables

HC.5.2 Therapeutic appliances and other medical durables Separation of this item is only possible for public expenditure

HC.5.2.1 Glasses and other vision products Only Civil Servants Insurance provides these products in the public sector. For the private sector it is not possible to separate from Other Therapeutic Appliances.

HC.5.2.2 Orthopaedic appliances and other prosthetics

HC.5.2.3 Hearing aids

HC.5.2.4 Medico-technical devices, including wheelchairs

HC.5.2.9 All other miscellaneous medical durables

HC.6 Prevention and public health services


26

HC.6.1 Maternal and child health; family planning and counselling

Includes services delivered by Health Centres related to childhood care and prevention, such as childbirth advising and training, prevention of mouth diseases or compulsory child vaccinations. Only covers public expenditure

HC.6.2 School health services

HC.6.3 Prevention of communicable diseases It mainly includes AIDS prevention campaigns.

HC.6.4 Prevention of non-communicable diseases

HC.6.5 Occupational health care Occupational health care of private enterprises and public non health care institutions is not included. Only includes medical check-ups for employees, carried out by Friendly Societies of Industrial Accidents and Occupational Disease (Social Security System)

HC.6.9 All other miscellaneous public health services

HC.7 Health administration and health insurance

HC.7.1 General government administration of health

HC.7.1.1 General government administration of health (except social security)

HC.7.1.2 Administration, operation and support activities of social security funds

HC.7.2 Health administration and health insurance: private

HC.7.2.1 Health administration and health insurance: social insurance

HC.7.2.2 Health administration and health insurance: other private

Health Related Expenditures

HC.R.1 Capital formation of health care provider institutions

HC.R.2 Education and training of health personnel It mainly includes transfers to Universities for specific training programs. A small amount of personnel costs relating to Medicine Faculties and Nursery Schools are included in HC11

HC.R.3 Research and development in health Most of the Research in Health is carried out in Hospitals, but the Heath Institute Carlos III, dependent on the Health Ministry, funds it to around 70%. From 2000 on, this Institute also finances some Public Research Foundations.

HC.R.4 Food, hygiene and drinking water control

HC.R.5 Environmental health

HC.R.6 Administration and provision of social services in kind to assist living with disease and impairment

HC.R.7 Administration and provision of health-related cash-benefits


27

Health Expenditure by Provider


HP.1 Hospitals

HP.1.1 General hospitals

HP.1.2 Mental health and substance abuse hospitals

HP.1.3 Speciality (other than mental health and substance abuse) hospitals

Includes Long-stay hospitals and other acute care hospitals such as oncological, ophthalmic, surgical, rehabilitation and orthopaedics hospitals, diseases of lung and tuberculosis hospitals.

HP.2 Nursing and residential care facilities Not included. These kinds of institutions are dependant on the Social Services of the Autonomous Communities and on the Labour and Social Affairs Ministry.

HP.2.1 Nursing care facilities

HP.2.2 Residential mental retardation, mental health and substance abuse facilities

HP.2.3 Community care facilities for the elderly

HP.2.9 All other residential care facilities

HP.3 Providers of ambulatory health care For private expenditure the separation is not available from the COICOP group 6.2 Outpatient services.

HP.3.1 Offices of physicians Includes services from private doctors contracted by the public sector, mainly by Civil Servants Insurance. It is considered as public expenditure. As for the private expenditure, separation is not available from outpatient services (COICOP 6.2.) So, it includes all providers of outpatient services to householders unless Hospitals.

HP.3.2 Offices of dentists For private expenditure it is not possible to separate from outpatient services (COICOP 6.2.)

HP.3.3 Offices of other health practitioners Only includes rehabilitation services contracted by the public sector from private health practitioners; around a third of this expenditure comes from the Friendly Societies of Industrial Accidents and Occupational Disease (Social Security System)

HP.3.4 Outpatient care centres

HP.3.4.1 Family planning centres

HP.3.4.2 Outpatient mental health and substance abuse centres

HP.3.4.3 Free-standing ambulatory surgery centres

HP.3.4.4 Dialysis care centres Includes outpatient dialysis services contracted by the public sector from “Dialysis Clubs” and other private outpatient dialysis centres.

HP.3.4.5 All other outpatient multi-speciality and co-operative service centres

It includes the expenditure of the “Health Centres” that are the core of the Primary Care. They carry out preventive, curative and rehabilitative functions. This item also includes Services of Urgent Transport (“061” Service) that depend of the Primary Care Administration as well as Health Centres.

HP.3.4.9 All other outpatient community and other integrated care centres

HP.3.5 Medical and diagnostic laboratories Only includes outpatient diagnostic imaging services contracted by the public sector from private providers. For private expenditure it is not possible to desegregate from outpatient services (COICOP 6.2.)

HP.3.6 Providers of home health care services Only includes outpatient services of oxygen-therapy and other home therapies contracted by the public sector from private providers. For private expenditure it is not possible to desegregate from outpatient services (COICOP 6.2.)

HP.3.9 Other providers of ambulatory health care

HP.3.9.1 Ambulance services Only includes ambulance services contracted by the public sector from private enterprises. Public ambulances are included in HP1.1 or HP 3.4.5. For private expenditure it is not possible to desegregate from outpatient services (COICOP 6.2.)

HP.3.9.2 Blood and organ banks Included in HP 1.1.

HP.3.9.9 Providers of all other ambulatory health care services


28

HP.4 Retail sale and other providers of medical goods

HP.4.1 Dispensing chemists

HP.4.2 Retail sale and other suppliers of optical glasses and other vision products

Not covered by the National Health Service (See HC 5.2.1) As for the private expenditure it is not possible to desegregate from Therapeutic appliances (COICOP 6.1.3)

HP.4.3 Retail sale and other suppliers of hearing aids Not covered by the National Health Service. For private expenditure it is not possible to desegregate from Therapeutic appliances (COICOP 6.1.3)

HP.4.4 Retail sale and other suppliers of medical appliances (other than optical glasses and hearing aids)

For private expenditure it is not possible to desegregate from Therapeutic appliances (COICOP 6.1.3)

HP.4.9 All other miscellaneous sale and other suppliers of pharmaceuticals and medical goods

HP.5 Provision and administration of public health programmes

HP.6 General health administration and insurance

HP.6.1 Government administration of health

HP.6.2 Social security funds

HP.6.3 Other social insurance

HP.6.4 Other (private) insurance Only includes administration costs related to health from the private insurance companies. The health services delivered or paid are included according to their function and provider.

HP.6.9 All other providers of health administration

HP.7 Other industries (rest of the economy) Includes public transfers to Universities for specific training programs. Also includes transfers to householders and NPISHs, but it is not available to separate them.

HP.7.1 Establishments as providers of occupational health care services

HP.7.2 Private households as providers of home care

HP.7.9 All other industries as secondary producers of health care

HP.9 Rest of the world It mainly includes specific medicines that are not allowed to be sold in Spain but are necessary for specific treatments. Also includes fees for health international organisations.


29

ANNEX 2: TABLES

Table A1 First available year Last available year

Total health expenditure by financing agents 1999 2001

million Euros percent million Euros percent

HF.1 General government 30,681 72.2% 35,131 71.5% HF.1.1 General government excluding social security funds 27,804 65.4% 31,904 65.0%

HF.1.1.1 Central government 25,037 58.9% 28,680 58.4% HF.1.1.2;1.1.3 Provincial/local government 2,767 6.5% 3,225 6.6% HF.1.2 Social security funds 2,877 6.8% 3,227 6.6%

HF.2 Private sector 11,831 27.8% 13,990 28.5% HF.2.1 Private social insurance - - - -

HF.2.2 Private insurance enterprises (other than social insurance) 1,595 3.8% 1,967 4.0%

HF.2.3 Private household out-of-pocket expenditure 9,852 23.2% 11,588 23.6%

HF.2.4 Non-profit institutions serving households (other than social insurance) 384 0.9% 435 0.9%

HF.2.5 Corporations (other than health insurance) - - - - HF.3 Rest of the world - - - - Total health expenditure (Spanish NHE) 42,511 100% 49,121 100% Note: There is a slight difference between Total health expenditure reported in Table A1 and Table A2 due to the financing agent expenditure being based on the nationally reported statistics (EGSP). Spanish National Health Expenditure (NHE) for 2001 is 0.27% higher than the SHA-based Total Health Expenditure


30


Health expenditure by function of care 1999 2001


HC.1;2 Services of curative & rehabilitative care 27,016 63.7% 30,776 62.8%

HC.1.1;2.1 Inpatient curative & rehabilitative care 11,409 26.9% 12,873 26.3%

HC.1.2;2.2 Day cases of curative & rehabilitative care 393 0.9% 442 0.9%

HC.1.3;2.3 Outpatient curative & rehabilitative care 15,020 35.4% 17,264 35.2%

HC.1.4;2.4 Home care (curative & rehabilitative) 193 0.5% 197 0.4%

HC.3 Services of long-term nursing care 868 2.0% 1,017 2.1%

HC.3.1 Inpatient long-term nursing care 861 2.0% 1,011 2.1%

HC.3.2 Day cases of long-term nursing care - - - -

HC.3.3 Home care (long term nursing care) 6 0.0% 7 0.0%

HC.4 Ancillary services to health care 1,370 3.2% 1,589 3.2%

HC.4.1 Clinical laboratory 480 1.1% 539 1.1%

HC.4.2 Diagnostic imaging 437 1.0% 488 1.0%

HC.4.3 Patient transport and emergency rescue 454 1.1% 562 1.1%

HC.4.9 All other miscellaneous ancillary services - - - -

HC.5 Medical goods dispensed to outpatients 10,452 24.7% 12,242 25.0%

HC.5.1 Pharmaceuticals and other medical non-durables 9,083 21.4% 10,507 21.4%

HC.5.2 Therapeutic appliances and other medical durables 1,369 3.2% 1,735 3.5%

HC.6 Prevention and public health services 548 1.3% 680 1.4%

HC.7 Health administration and health insurance 895 2.1% 1,105 2.3%

CURRENT HEALTH EXPENDITURE 41,149 97.1% 47,408 96.8%

HC.R.1 Capital formation of health care provider institutions 1,243 2.9% 1,579 3.2%

TOTAL HEALTH EXPENDITURE 42,392 100.0% 48,987 100.0%


31


Current health expenditure by mode of production 1999 2001


Inpatient care 12,271 29.8% 13,884 29.3%

HC.1.1;2.1 Curative & rehabilitative care 11,409 27.7% 12,873 27.2%

HC.3.1 Long-term nursing care 861 2.1% 1,011 2.1%

Services of day-care 393 1.0% 442 0.9%

HC.1.2;2.2 Day cases of curative & rehabilitative care 393 1.0% 442 0.9%

HC.3.2 Day cases of long-term nursing care - - - -

Outpatient care 15,020 36.5% 17,264 36.4%

HC.1.3;2.3 Outpatient curative & rehabilitative care 15,020 36.5% 17,264 36.4%

HC.1.3.1 Basic medical and diagnostic services - - - -

HC.1.3.2 Outpatient dental care - - - -

HC.1.3.3 All other specialised health care - - - -

HC.1.3.9;2.3 All other outpatient curative care - - - -

Home care 199 0.5% 203 0.4%

HC.1.4;2.4 Home care (curative & rehabilitative) 193 0.5% 197 0.4%

HC.3.3 Home care (long term nursing care) 6 0.0% 7 0.0%

HC.4 Ancillary services to health care 1,370 3.3% 1,589 3.4%

HC.5 Medical goods dispensed to outpatients 10,452 25.4% 12,242 25.8%

HC.5.1 Pharmaceuticals and other medical non-durables 9,083 22.1% 10,507 22.2%

HC.5.2 Therapeutic appliances and other medical durables 1,369 3.3% 1,735 3.7%

Total expenditure on personal health care 39,706 96.5% 45,623 96.2%

HC.6 Prevention and public health services 548 1.3% 680 1.4%

HC.7 Health administration and health insurance 895 2.2% 1,105 2.3%

Total current expenditure on health care 41,149 100.0% 47,408 100.0%


32


Current health expenditure by provider 1999 2001


HP.1 Hospitals 17,716 43.1% 20,061 42.3%

HP.2 Nursing and residential care facilities - - - -

HP.3 Providers of ambulatory health care 11,547 28.1% 13,419 28.3%

HP.3.1 Offices of physicians 6,071 14.8% 7,126 15.0%

HP.3.2 Offices of dentists 17 0.0% 17 0.0%

HP.3.3-3.9 All other providers of ambulatory health care 5,459 13.3% 6,275 13.2%

HP.4 Retail sale and other providers of medical goods 10,357 25.2% 12,119 25.6%

HP.5 Provision and administration of public health programmes

300 0.7% 406 0.9%

HP.6 General health administration and insurance 1,014 2.5% 1,242 2.6%

HP.6.1 Government administration of health 507 1.2% 604 1.3%

HP.6.2 Social security funds 311 0.8% 351 0.7%

HP.6.3;6.4 Other social insurance 196 0.5% 286 0.6%

HP.7 Other industries (rest of the economy) 213 0.5% 157 0.3%

HP.7.1 Occupational health care services - - - -

HP.7.2 Private households as providers of home care - - - -

HP.7.9 All other secondary producers of health care - - - -

HP.9 Rest of the world 3 0.0% 5 0.0%

Total current expenditure on health care 41,149 100.0% 47,408 100.0%

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HC

.1.4

; 2.4

197

56

14

1

-

-

-

-

-

14

1

-

-

-

-

-

-

-

-

-

-

-

Long

-ter

m n

ursi

ng

care

HC

.3.3

7

-

7

-

-

-

7

-

-

-

-

-

-

-

-

-

-

-

-

-

Anc

illar

y se

rvic

esH

C.4

1,58

9

90

6

586

-

-

-

134

14

4

-

30

8

-

-

-

-

-

-

-

-

96

-

Med

ical

goo

dsH

C.5

12,2

42

-

-

119

-

-

-

119

-

-

-

12,1

19

10,3

85

1,73

5

-

-

-

-

-

-

4

Pha

rmac

eutic

als

/ no

n-du

rabl

esH

C.5

.110

,507

-

119

-

-

-

119

-

-

-

10,3

85

10,3

85

-

-

-

-

-

-

-

4

The

rape

utic

ap

plia

nces

HC

.5.2

1,73

5

-

-

-

-

-

-

-

-

-

1,73

5

-

1,73

5

-

-

-

-

-

-

-

45,6

23

20,0

61

-

13

,283

7,

126

17

25

5,52

2

14

4

141

30

8

12,1

19

10,3

85

1,73

5

-

-

-

-

-

156

4

Pre

vent

ion

and

publ

ic

heal

th s

ervi

ces

HC

.668

0

-

13

6

-

-

-

13

6

-

-

-

-

-

-

406

13

8

-

13

8

-

0

1

Hea

lth a

dmin

istr

atio

n an

d he

alth

insu

ranc

eH

C.7

1,10

5

-

-

-

-

-

-

-

-

-

-

-

-

-

1,10

5

60

4

214

28

6

-

1

47,4

08

20,0

61

-

13

,419

7,

126

17

25

5,65

8

14

4

141

30

8

12,1

19

10,3

85

1,73

5

40

6

1,24

2

60

4

351

28

6

157

5

Tota

l exp

end

itu

re o

n p

erso

nal

hea

lth

ca

re

SH

A T

able

2.1

Cu

rren

t ex

pen

dit

ure

on

hea

lth

by

fun

ctio

n o

f ca

re a

nd

pro

vid

er in

du

stry

(E

UR

, mill

ions

)

Tota

l cu

rren

t h

ealt

h e

xpen

dit

ure

Total current health expenditure

DE

LSA

/EL

SA/W

D/H

TP(

2004

)11

34

AN

NE

X 3

: SP

AIN

200

1 SH

A T

AB

LE

S

HP

.1H

P.2

HP

.3H

P.3

.1H

P.3

.2H

P.3

.3H

P.3

.4H

P.3

.5H

P.3

.6H

P.3

.9H

P.4

HP

.4.1

HP

.4.2

-4.

9H

P.5

HP

.6H

P.6

.1H

P.6

.2H

P.6

.3,

6.4

HP

.7H

P.9

Hea

lth c

are

by fu

nctio

nIC

HA

-HC

co

de

Hospitals


facilities



Offices of dentists


practitioners



laboratories


servicesAll other


care


Dispensing chemists






Private insurance


Rest of the world

In-p

atie

nt c

are

100.

0

10

0.0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Cur

ativ

e an

d re

habi

litat

ive

care

HC

.1.1

; 2.1

100.

0

10

0.0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Long

-ter

m n

ursi

ng

care

HC

.3.1

100.

0

10

0.0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Ser

vice

s of

day

-car

e10

0.0

54.5

-

45

.5

-

-

-

45.5

-

-

-

-

-

-

-

-

-

-

-

-

-

Cur

ativ

e an

d re

habi

litat

ive

care

HC

.1.2

; 2.2

100.

0

54

.5

-

45.5

-

-

-

45

.5

-

-

-

-

-

-

-

-

-

-

-

-

-

Long

-ter

m n

ursi

ng

care

HC

.3.2

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Out

-pat

ient

car

e10

0.0

28.8

-

70

.8

41

.3

0.

1

0.1

29

.3

-

-

-

-

-

-

-

-

-

-

-

0.3

-

Bas

ic m

edic

al a

nd

diag

nost

ic s

ervi

ces

HC

.1.3

.1-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Out

-pat

ient

den

tal

care

HC

.1.3

.2-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

All

othe

r sp

ecia

lised

he

alth

car

eH

C.1

.3.3

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

All

othe

r ou

t-pa

tient

ca

reH

C.1

.3.9

; 2.

3-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Hom

e ca

re10

0.0

27.5

-

72

.5

-

-

-

3.2

-

69.3

-

-

-

-

-

-

-

-

-

-

-

Cur

ativ

e an

d re

habi

litat

ive

care

HC

.1.4

; 2.4

100.

0

28

.4

-

71.6

-

-

-

-

-

71

.6

-

-

-

-

-

-

-

-

-

-

-

Long

-ter

m n

ursi

ng

care

HC

.3.3

100.

0

-

-

10

0.0

-

-

-

10

0.0

-

-

-

-

-

-

-

-

-

-

-

-

-

Anc

illar

y se

rvic

esH

C.4

100.

0

57

.1

-

36.9

-

-

-

8.

5

9.1

-

19.4

-

-

-

-

-

-

-

-

6.0

-

Med

ical

goo

dsH

C.5

100.

0

-

-

1.

0

-

-

-

1.

0

-

-

-

99

.0

84

.8

14

.2

-

-

-

-

-

-

0.

0

Pha

rmac

eutic

als

/ no

n-du

rabl

esH

C.5

.110

0.0

-

-

1.1

-

-

-

1.1

-

-

-

98.8

98.8

-

-

-

-

-

-

-

0.

0

The

rape

utic

ap

plia

nces

HC

.5.2

100.

0

-

-

-

-

-

-

-

-

-

-

10

0.0

-

10

0.0

-

-

-

-

-

-

-

100.

0

44

.0

-

29.1

15.6

0.0

0.

1

12.1

0.3

0.

3

0.7

26

.6

22

.8

3.

8

-

-

-

-

-

0.

3

0.

0

Pre

vent

ion

and

publ

ic

heal

th s

ervi

ces

HC

.610

0.0

-

-

20.0

-

-

-

20

.0

-

-

-

-

-

-

59

.7

20

.2

-

20.2

-

0.

0

0.

1

Hea

lth a

dmin

istr

atio

n an

d he

alth

insu

ranc

eH

C.7

100.

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

99

.9

54

.7

19

.3

25

.9

-

0.1

100.

0

42

.3

-

28.3

15.0

0.0

0.

1

11.9

0.3

0.

3

0.6

25

.6

21

.9

3.

7

0.9

2.

6

1.3

0.

7

0.6

0.

3

0.

0

Tota

l exp

end

itu

re o

n p

erso

nal

hea

lth

ca

re

SH

A T

able

2.2

Cu

rren

t ex

pen

dit

ure

on

hea

lth

by

fun

ctio

n o

f ca

re a

nd

pro

vid

er in

du

stry

(%

of

expe

nditu

re o

n fu

nctio

nal c

ateg

orie

s)

Tota

l cu

rren

t h

ealt

h e

xpen

dit

ure


D

EL

SA/E

LSA

/WD

/HT

P(20

04)1

1

35

SPA

IN 2

001

HP

.1H

P.2

HP

.3H

P.3

.1H

P.3

.2H

P.3

.3H

P.3

.4H

P.3

.5H

P.3

.6H

P.3

.9H

P.4

HP

.4.1

HP

.4.2

-4.

9H

P.5

HP

.6H

P.6

.1H

P.6

.2H

P.6

.3,

6.4

HP

.7H

P.9

Hea

lth c

are

by fu

nctio

nIC

HA

-HC

co

de

Hospitals


facilities



Offices of dentists


practitioners



laboratories


servicesAll other


care


Dispensing chemists






Private insurance


Rest of the world

In-p

atie

nt c

are

29.3

69.2

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Cur

ativ

e an

d re

habi

litat

ive

care

HC

.1.1

; 2.1

27.2

64.2

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Long

-ter

m n

ursi

ng

care

HC

.3.1

2.1

5.

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Ser

vice

s of

day

-car

e0.

9

1.2

-

1.

5

-

-

-

3.

6

-

-

-

-

-

-

-

-

-

-

-

-

-

Cur

ativ

e an

d re

habi

litat

ive

care

HC

.1.2

; 2.2

0.9

1.

2

-

1.5

-

-

-

3.6

-

-

-

-

-

-

-

-

-

-

-

-

-

Long

-ter

m n

ursi

ng

care

HC

.3.2

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Out

-pat

ient

car

e36

.4

24

.8

-

91

.1

10

0.0

100.

0

10

0.0

89.5

-

-

-

-

-

-

-

-

-

-

-

38

.5

-

Bas

ic m

edic

al a

nd

diag

nost

ic s

ervi

ces

HC

.1.3

.1-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Out

-pat

ient

den

tal

care

HC

.1.3

.2-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

All

othe

r sp

ecia

lised

he

alth

car

eH

C.1

.3.3

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

All

othe

r ou

t-pa

tient

ca

reH

C.1

.3.9

; 2.

3-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Hom

e ca

re0.

4

0.3

-

1.

1

-

-

-

0.

1

-

10

0.0

-

-

-

-

-

-

-

-

-

-

-

Cur

ativ

e an

d re

habi

litat

ive

care

HC

.1.4

; 2.4

0.4

0.

3

-

1.0

-

-

-

-

-

100.

0

-

-

-

-

-

-

-

-

-

-

-

Long

-ter

m n

ursi

ng

care

HC

.3.3

0.0

-

-

0.0

-

-

-

0.1

-

-

-

-

-

-

-

-

-

-

-

-

-

Anc

illar

y se

rvic

esH

C.4

3.4

4.

5

-

4.4

-

-

-

2.4

10

0.0

-

10

0.0

-

-

-

-

-

-

-

-

61.3

-

Med

ical

goo

dsH

C.5

25.8

-

-

0.

9

-

-

-

2.

1

-

-

-

10

0.0

100.

0

10

0.0

-

-

-

-

-

-

71.6

Pha

rmac

eutic

als

/ no

n-du

rabl

esH

C.5

.122

.2

-

-

0.9

-

-

-

2.1

-

-

-

85.7

100.

0

-

-

-

-

-

-

-

71.6

The

rape

utic

ap

plia

nces

HC

.5.2

3.7

-

-

-

-

-

-

-

-

-

-

14.3

-

10

0.0

-

-

-

-

-

-

-

96.2

100.

0

-

99

.0

10

0.0

100.

0

10

0.0

97.6

100.

0

10

0.0

100.

0

10

0.0

100.

0

10

0.0

-

-

-

-

-

99

.9

71.6

Pre

vent

ion

and

publ

ic

heal

th s

ervi

ces

HC

.61.

4

-

-

1.

0

-

-

-

2.

4

-

-

-

-

-

-

100.

0

11

.1

-

39.2

-

0.

1

16

.1

Hea

lth a

dmin

istr

atio

n an

d he

alth

insu

ranc

eH

C.7

2.3

-

-

-

-

-

-

-

-

-

-

-

-

-

-

88.9

100.

0

60

.8

10

0.0

-

12

.3

100.

0

10

0.0

-

100.

0

10

0.0

100.

0

10

0.0

100.

0

10

0.0

100.

0

10

0.0

100.

0

10

0.0

100.

0

10

0.0

100.

0

10

0.0

100.

0

10

0.0

100.

0

100.

0

Tota

l exp

end

itu

re o

n p

erso

nal

hea

lth

ca

re

SH

A T

able

2.3

Cu

rren

t ex

pen

dit

ure

on

hea

lth

by

fun

ctio

n o

f ca

re a

nd

pro

vid

er in

du

stry

(%

of

prov

ider

cat

egor

y ex

pend

iture

)

Tota

l cu

rren

t h

ealt

h e

xpen

dit

ure


DE

LSA

/EL

SA/W

D/H

TP(

2004

)11

36

SPA

IN 2

001

SH

A T

able

3.1

Cu

rren

t ex

pen

dit

ure

on

hea

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by

pro

vid

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du

stry

an

d s

ou

rce

of

fun

din

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EU

R, m

illio

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Tota

lH

F.1

HF

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HF

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HF.

2H

F.2

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HF

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HF

.2.3

HF

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HF

.2.5

HF

.3

expe

ndit

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Gen

eral

Priv

ate

HF

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HF

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Hea

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are

prov

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co

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on

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Gen

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vern

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rity)

Soc

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Non

-pro

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cial

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)

Cor

pora

tions

(o

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than

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alth

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sura

nce)

Res

t of t

he

wor

ld

Hos

pita

lsH

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20,0

61

17

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2,41

2

368

368

1,68

4

360

Nur

sing

and

res

iden

tial c

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litie

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-

-

-

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-

-

-

Pro

vide

rs o

f am

bula

tory

hea

lth c

are

HP

.313

,419

6,76

8

6,65

1

1,27

5

1,27

5

5,30

2

75

Offi

ces

of p

hysi

cian

sH

P.3

.17,

126

47

5

6,

651

1,

275

1,

275

5,

302

75

Offi

ces

of d

entis

tsH

P.3

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17

-

-

-

-

-

Offi

ces

of o

ther

hea

lth p

ract

ition

ers

HP

.3.3

25

25

-

-

-

-

-

Out

-pat

ient

car

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ntre

sH

P.3

.45,

658

5,

658

-

-

-

-

-

Med

ical

and

dia

gnos

tic la

bora

torie

sH

P.3

.514

4

14

4

-

-

-

-

-

Pro

vide

rs o

f hom

e he

alth

car

e se

rvic

esH

P.3

.614

1

14

1

-

-

-

-

-

Oth

er p

rovi

ders

of a

mbu

lato

ry c

are

HP

.3.9

308

308

-

-

-

-

-

Ret

ail s

ale

of m

edic

al g

oods

HP

.412

,119

7,67

6

4,44

3

-

-

4,44

3

-

Dis

pens

ing

chem

ists

HP

.4.1

10,3

85

7,

535

2,

850

-

-

2,

850

-

All

othe

r sa

les

of m

edic

al g

oods

HP

.4.2

-4.9

1,73

5

141

1,59

3

-

-

1,59

3

-

Pro

vide

rs o

f pub

lic h

ealth

pro

gram

mes

HP

.540

6

40

6

-

-

-

-

-

Hea

lth a

dmin

istr

atio

n an

d in

sura

nce

HP

.61,

242

95

6

28

6

28

6

28

6

-

-

Gov

ernm

ent (

excl

udin

g so

cial

insu

ranc

e)H

P.6

.160

4

60

4

-

-

-

-

-

Soc

ial s

ecur

ity fu

nds

HP

.6.2

351

351

-

-

-

-

-

Oth

er s

ocia

l ins

uran

ceH

P.6

.3-

-

-

-

-

-

-

Oth

er (

priv

ate)

insu

ranc

eH

P.6

.428

6

-

28

6

28

6

28

6

-

-

All

othe

r pr

ovid

ers

of h

ealth

ad

min

istr

atio

nH

P.6

.9-

-

-

-

-

-

-

Oth

er in

dust

ries

(res

t of t

he e

cono

my)

HP

.715

7

15

7

-

-

-

-

-

Occ

upat

iona

l hea

lth c

are

HP

.7.1

-

-

-

-

-

Priv

ate

hous

ehol

dsH

P.7

.2-

-

-

-

-

All

othe

r se

cond

ary

prod

ucer

sH

P.7

.9-

-

-

-

-

Res

t of t

he w

orld

HP

.95

5

-

-

-

Tota

l exp

end

itur

e o

n h

ealt

h47

,408

33,6

16

-

-

13

,793

1,92

9

-

1,92

9

11,4

29

43

5

-

-

D

EL

SA/E

LSA

/WD

/HT

P(20

04)1

1

37

SPA

IN 2

001

SH

A T

able

3.2

Cu

rren

t ex

pen

dit

ure

on

hea

lth

by

pro

vid

er in

du

stry

an

d s

ou

rce

of

fun

din

g (

% o

f pro

vide

r ca

tego

ry e

xpen

ditu

re)

Tota

lH

F.1

HF

.1.1

HF

.1.2

HF.

2H

F.2

.1 +

HF

.2.2

HF

.2.3

HF

.2.4

HF

.2.5

HF

.3

expe

ndit

ure

Gen

eral

Priv

ate

HF

.2.1

HF

.2.2

Hea

lth c

are

prov

ider

cat

egor

yIC

HA

-HP

co

de

on

hea

lth

gove

rnm

ent

Gen

eral

go

vern

men

t (e

xcl.

soci

al

secu

rity)

Soc

ial s

ecur

ity

fund

sse

ctor

Priv

ate

in

sura

nce

Priv

ate

soci

al

insu

ranc

eO

ther

priv

ate

insu

ranc

eP

rivat

e ho

useh

old

out-

of-p

ocke

t pa

ymen

ts

Non

-pro

fit

orga

nisa

tions

(o

ther

than

so

cial

ins.

)

Cor

pora

tions

(o

ther

than

he

alth

in

sura

nce)

Res

t of t

he

wor

ld

Hos

pita

lsH

P.1

100.

0

88.0

-

-

12.0

1.8

-

1.8

8.4

1.8

-

-

Nur

sing

and

res

iden

tial c

are

faci

litie

sH

P.2

-

-

-

-

-

-

-

-

-

-

-

-

Pro

vide

rs o

f am

bula

tory

hea

lth c

are

HP

.310

0.0

50

.4

-

-

49

.6

9.

5

-

9.

5

39

.5

0.

6

-

-

Offi

ces

of p

hysi

cian

sH

P.3

.110

0.0

6.

7

-

-

93

.3

17

.9

-

17

.9

74

.4

1.

0

-

-

Offi

ces

of d

entis

tsH

P.3

.210

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Offi

ces

of o

ther

hea

lth p

ract

ition

ers

HP

.3.3

100.

0

100.

0

-

-

-

-

-

-

-

-

-

-

Out

-pat

ient

car

e ce

ntre

sH

P.3

.410

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Med

ical

and

dia

gnos

tic la

bora

torie

sH

P.3

.510

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Pro

vide

rs o

f hom

e he

alth

car

e se

rvic

esH

P.3

.610

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Oth

er p

rovi

ders

of a

mbu

lato

ry c

are

HP

.3.9

100.

0

100.

0

-

-

-

-

-

-

-

-

-

-

Ret

ail s

ale

of m

edic

al g

oods

HP

.410

0.0

63

.3

-

-

36

.7

-

-

-

36

.7

-

-

-

Dis

pens

ing

chem

ists

HP

.4.1

100.

0

72.6

-

-

27.4

-

-

-

27.4

-

-

-

All

othe

r sa

les

of m

edic

al g

oods

HP

.4.2

-4.9

100.

0

8.1

-

-

91.9

-

-

-

91.9

-

-

-

Pro

vide

rs o

f pub

lic h

ealth

pro

gram

mes

HP

.510

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Hea

lth a

dmin

istr

atio

n an

d in

sura

nce

HP

.610

0.0

76

.9

-

-

23

.1

23

.1

-

23

.1

-

-

-

-

Gov

ernm

ent (

excl

udin

g so

cial

insu

ranc

e)H

P.6

.110

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Soc

ial s

ecur

ity fu

nds

HP

.6.2

100.

0

100.

0

-

-

-

-

-

-

-

-

-

-

Oth

er s

ocia

l ins

uran

ceH

P.6

.3-

-

-

-

-

-

-

-

-

-

-

-

Oth

er (

priv

ate)

insu

ranc

eH

P.6

.410

0.0

-

-

-

10

0.0

10

0.0

-

10

0.0

-

-

-

-

All

othe

r pr

ovid

ers

of h

ealth

ad

min

istr

atio

nH

P.6

.9-

-

-

-

-

-

-

-

-

-

-

-

Oth

er in

dust

ries

(res

t of t

he e

cono

my)

HP

.710

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Occ

upat

iona

l hea

lth c

are

HP

.7.1

-

-

-

-

-

-

-

-

-

-

-

-

Priv

ate

hous

ehol

dsH

P.7

.2-

-

-

-

-

-

-

-

-

-

-

-

All

othe

r se

cond

ary

prod

ucer

sH

P.7

.9-

-

-

-

-

-

-

-

-

-

-

-

Res

t of t

he w

orld

HP

.910

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Tota

l exp

end

itur

e o

n h

ealt

h10

0.0

70

.9

-

-

29

.1

4.

1

-

4.

1

24

.1

0.

9

-

-

DE

LSA

/EL

SA/W

D/H

TP(

2004

)11

38

SPA

IN 2

001

SH

A T

able

3.3

Cu

rren

t ex

pen

dit

ure

on

hea

lth

by

pro

vid

er in

du

stry

an

d s

ou

rce

of

fun

din

g (

% o

f exp

endi

ture

by

finan

cing

age

nt c

ateg

ory)

Tota

lH

F.1

HF

.1.1

HF

.1.2

HF

.2H

F.2

.1 +

HF

.2.2

HF

.2.3

HF

.2.4

HF

.2.5

HF

.3

exp

end

itu

reG

ener

alP

rivat

eH

F.2

.1H

F.2

.2

Hea

lth c

are

prov

ider

cat

egor

yIC

HA

-HP

co

de

on

hea

lth

gove

rnm

ent

Gen

eral

go

vern

men

t (e

xcl.

soci

al

secu

rity)

Soc

ial s

ecur

ity

fund

sse

ctor

Priv

ate

in

sura

nce

Priv

ate

soci

al

insu

ranc

eO

ther

priv

ate

insu

ranc

eP

rivat

e ho

useh

old

out-

of-p

ocke

t pa

ymen

ts

Non

-pro

fit

orga

nisa

tions

(o

ther

than

so

cial

ins.

)

Cor

pora

tions

(o

ther

than

he

alth

in

sura

nce)

Res

t of t

he

wor

ld

Hos

pita

lsH

P.1

42.3

52.5

-

-

17.5

19.1

-

19.1

14.7

82.8

-

-

Nur

sing

and

res

iden

tial c

are

faci

litie

sH

P.2

-

-

-

-

-

-

-

-

-

-

-

-

Pro

vide

rs o

f am

bula

tory

hea

lth c

are

HP

.328

.3

20

.1

-

-

48

.2

66

.1

-

66

.1

46

.4

17

.2

-

-

Offi

ces

of p

hysi

cian

sH

P.3

.115

.0

1.

4

-

-

48

.2

66

.1

-

66

.1

46

.4

17

.2

-

-

Offi

ces

of d

entis

tsH

P.3

.20.

0

0.1

-

-

-

-

-

-

-

-

-

-

Offi

ces

of o

ther

hea

lth p

ract

ition

ers

HP

.3.3

0.1

0.

1

-

-

-

-

-

-

-

-

-

-

Out

-pat

ient

car

e ce

ntre

sH

P.3

.411

.9

16

.8

-

-

-

-

-

-

-

-

-

-

Med

ical

and

dia

gnos

tic la

bora

torie

sH

P.3

.50.

3

0.4

-

-

-

-

-

-

-

-

-

-

Pro

vide

rs o

f hom

e he

alth

car

e se

rvic

esH

P.3

.60.

3

0.4

-

-

-

-

-

-

-

-

-

-

Oth

er p

rovi

ders

of a

mbu

lato

ry c

are

HP

.3.9

0.6

0.

9

-

-

-

-

-

-

-

-

-

-

Ret

ail s

ale

of m

edic

al g

oods

HP

.425

.6

22

.8

-

-

32

.2

-

-

-

38

.9

-

-

-

Dis

pens

ing

chem

ists

HP

.4.1

21.9

22.4

-

-

20.7

-

-

-

24.9

-

-

-

All

othe

r sa

les

of m

edic

al g

oods

HP

.4.2

-4.9

3.7

0.

4

-

-

11

.6

-

-

-

13

.9

-

-

-

Pro

vide

rs o

f pub

lic h

ealth

pro

gram

mes

HP

.50.

9

1.2

-

-

-

-

-

-

-

-

-

-

Hea

lth a

dmin

istr

atio

n an

d in

sura

nce

HP

.62.

6

2.8

-

-

2.1

14.9

-

14.9

-

-

-

-

Gov

ernm

ent (

excl

udin

g so

cial

insu

ranc

e)H

P.6

.11.

3

1.8

-

-

-

-

-

-

-

-

-

-

Soc

ial s

ecur

ity fu

nds

HP

.6.2

0.7

1.

0

-

-

-

-

-

-

-

-

-

-

Oth

er s

ocia

l ins

uran

ceH

P.6

.3-

-

-

-

-

-

-

-

-

-

-

-

Oth

er (

priv

ate)

insu

ranc

eH

P.6

.40.

6

-

-

-

2.1

14.9

-

14.9

-

-

-

-

All

othe

r pr

ovid

ers

of h

ealth

ad

min

istr

atio

nH

P.6

.9-

-

-

-

-

-

-

-

-

-

-

-

Oth

er in

dust

ries

(res

t of

the

econ

omy)

HP

.70.

3

0.5

-

-

-

-

-

-

-

-

-

-

Occ

upat

iona

l hea

lth c

are

HP

.7.1

-

-

-

-

-

-

-

-

-

-

-

-

Priv

ate

hous

ehol

dsH

P.7

.2-

-

-

-

-

-

-

-

-

-

-

-

All

othe

r se

cond

ary

prod

ucer

sH

P.7

.9-

-

-

-

-

-

-

-

-

-

-

-

Res

t of t

he w

orld

HP

.90.

0

0.0

-

-

-

-

-

-

-

-

-

-

Tota

l exp

end

itu

re o

n h

ealt

h10

0.0

10

0.0

-

-

10

0.0

10

0.0

-

10

0.0

10

0.0

10

0.0

-

-

D

EL

SA/E

LSA

/WD

/HT

P(20

04)1

1

39

SPA

IN 2

001

SH

A T

able

4.1

Cu

rren

t ex

pen

dit

ure

on

hea

lth

by

fun

ctio

n o

f ca

re a

nd

so

urc

e o

f fu

nd

ing

(E

UR

, mill

ions

)

To

tal

HF

.1H

F.1

.1H

F.1

.2H

F.2

HF

.2.1

+ H

F.2

.2H

F.2

.3H

F.2

.4H

F.2

.5H

F.3

curr

ent

Gen

eral

Priv

ate

HF

.2.1

HF

.2.2

Hea

lth c

are

func

tion

ICH

A-H

C

code

exp

.go

vern

men

tG

ener

al

gove

rnm

ent

(exc

l. so

cial

se

curit

y)

Soc

ial

secu

rity

fund

sse

ctor

Priv

ate

insu

ranc

eP

rivat

e so

cial

in

sura

nce

sche

mes

Oth

er p

rivat

e in

sura

nce

Priv

ate

hous

ehol

d ou

t-of

-poc

ket

paym

ents

Non

-pro

fit

inst

itutio

ns

(oth

er th

an

soci

al

insu

ranc

e)

Cor

pora

tions

(o

ther

than

he

alth

in

sura

nce)

Res

t of t

he

wor

ld

Per

sona

l hea

lth c

are

serv

ices

HC

.1-H

C.4

33,3

82

24

,319

-

-

9,06

3

1,64

2

-

1,

642

6,

986

43

5

-

-

In-p

atie

nt s

ervi

ces

13,8

84

12

,154

1,73

0

235

23

5

1,

134

36

0

Day

car

e se

rvic

es44

2

44

2

-

-

-

-

-

Out

-pat

ient

ser

vice

s17

,264

9,93

1

7,33

3

1,40

7

1,40

7

5,85

2

75

Hom

e ca

re s

ervi

ces

203

203

-

-

-

-

-

Anc

illar

y se

rvic

esH

C.4

1,58

9

1,58

9

-

-

-

-

-

Med

ical

goo

ds to

out

-pat

ient

sH

C.5

12,2

42

7,

798

-

-

4,

443

-

-

-

4,

443

-

-

-

Pha

rmac

eutic

als

HC

.5.1

10,5

07

7,

657

2,

850

-

-

2,85

0

-

The

rape

utic

app

lianc

esH

C.5

.21,

735

14

1

1,

593

-

-

1,59

3

-

Per

sona

l hea

lth c

are

serv

ices

an

d go

ods

HC

.1-H

C.5

45,6

23

32

,117

-

-

13,5

06

1,

642

-

1,64

2

11,4

29

43

5

-

-

Pre

vent

ion

and

publ

ic h

ealth

HC

.668

0

68

0

-

-

-

-

-

Hea

lth a

dmin

. and

insu

ranc

eH

C.7

1,10

5

819

286

286

28

6

-

-

Cu

rren

t ex

pen

dit

ure

on

hea

lth

car

e47

,408

33,6

16

-

-

13

,793

1,92

9

-

1,

929

11

,429

435

-

-

DE

LSA

/EL

SA/W

D/H

TP(

2004

)11

40

SPA

IN 2

001

SH

A T

able

4.2

Cu

rren

t ex

pen

dit

ure

on

hea

lth

by

fun

ctio

n o

f ca

re a

nd

so

urc

e o

f fu

nd

ing

(%

of e

xpen

ditu

re o

n fu

nctio

nal c

ateg

ory

(mod

e of

pro

duct

ion)

)

To

tal

HF

.1H

F.1

.1H

F.1

.2H

F.2

HF

.2.1

+ H

F.2

.2H

F.2

.3H

F.2

.4H

F.2

.5H

F.3

curr

ent

Gen

eral

Priv

ate

HF

.2.1

HF

.2.2

Hea

lth c

are

func

tion

ICH

A-H

C

code

exp

.go

vern

men

tG

ener

al

gove

rnm

ent

(exc

l. so

cial

se

curit

y)

Soc

ial

secu

rity

fund

sse

ctor

Priv

ate

insu

ranc

eP

rivat

e so

cial

in

sura

nce

sche

mes

Oth

er p

rivat

e in

sura

nce

Priv

ate

hous

ehol

d ou

t-of

-poc

ket

paym

ents

Non

-pro

fit

inst

itutio

ns

(oth

er th

an

soci

al

insu

ranc

e)

Cor

pora

tions

(o

ther

than

he

alth

in

sura

nce)

Res

t of t

he

wor

ld

Per

sona

l hea

lth c

are

serv

ices

HC

.1-H

C.4

100.

0

72.9

-

-

27.1

4.

9

-

4.9

20.9

1.3

-

-

In-p

atie

nt s

ervi

ces

100.

0

87.5

-

-

12.5

1.

7

-

1.7

8.2

2.

6

-

-

Day

car

e se

rvic

es10

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Out

-pat

ient

ser

vice

s10

0.0

57

.5

-

-

42

.5

8.1

-

8.

1

33

.9

0.

4

-

-

Hom

e ca

re s

ervi

ces

100.

0

100.

0

-

-

-

-

-

-

-

-

-

-

Anc

illar

y se

rvic

esH

C.4

100.

0

100.

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Med

ical

goo

ds to

out

-pat

ient

sH

C.5

100.

0

63.7

-

-

36.3

-

-

-

36

.3

-

-

-

Pha

rmac

eutic

als

HC

.5.1

100.

0

72.9

-

-

27.1

-

-

-

27

.1

-

-

-

The

rape

utic

app

lianc

esH

C.5

.210

0.0

8.

1

-

-

91.9

-

-

-

91

.9

-

-

-

Per

sona

l hea

lth c

are

serv

ices

an

d go

ods

HC

.1 -

HC

.510

0.0

70

.4

-

-

29

.6

3.6

-

3.

6

25

.1

1.

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Pre

vent

ion

and

publ

ic h

ealth

HC

.610

0.0

10

0.0

-

-

-

-

-

-

-

-

-

-

Hea

lth a

dmin

. and

insu

ranc

eH

C.7

100.

0

74.1

-

-

25.9

25

.9

-

25

.9

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Cu

rren

t ex

pen

dit

ure

on

hea

lth

car

e10

0.0

70

.9

-

-

29

.1

4.1

-

4.

1

24

.1

0.

9

-

-

D

EL

SA/E

LSA

/WD

/HT

P(20

04)1

1

41

SPA

IN 2

001

SH

A T

able

4.3

Cu

rren

t ex

pen

dit

ure

on

hea

lth

by

fun

ctio

n o

f ca

re a

nd

so

urc

e o

f fu

nd

ing

(%

of e

xpen

ditu

re b

y fin

anci

ng a

gent

cat

egor

y)

To

tal

HF

.1H

F.1

.1H

F.1

.2H

F.2

HF

.2.1

+ H

F.2

.2H

F.2

.3H

F.2

.4H

F.2

.5H

F.3

curr

ent

Gen

eral

Priv

ate

HF

.2.1

HF

.2.2

Hea

lth c

are

func

tion

ICH

A-H

C

code

exp

.go

vern

men

tG

ener

al

gove

rnm

ent

(exc

l. so

cial

se

curit

y)

Soc

ial

secu

rity

fund

sse

ctor

Priv

ate

insu

ranc

eP

rivat

e so

cial

in

sura

nce

sche

mes

Oth

er p

rivat

e in

sura

nce

Priv

ate

hous

ehol

d ou

t-of

-poc

ket

paym

ents

Non

-pro

fit

inst

itutio

ns

(oth

er th

an

soci

al

insu

ranc

e)

Cor

pora

tions

(o

ther

than

he

alth

in

sura

nce)

Res

t of t

he

wor

ld

Per

sona

l hea

lth c

are

serv

ices

HC

.1-H

C.4

70.4

72

.3

-

-

65

.7

85.1

-

85

.1

61.1

100.

0

-

-

In-p

atie

nt s

ervi

ces

29.3

36

.2

-

-

12

.5

12.2

-

12

.2

9.9

82

.8

-

-

Day

car

e se

rvic

es0.

9

1.3

-

-

-

-

-

-

-

-

-

-

Out

-pat

ient

ser

vice

s36

.4

29.5

-

-

53.2

72

.9

-

72.9

51

.2

17

.2

-

-

Hom

e ca

re s

ervi

ces

0.4

0.

6

-

-

-

-

-

-

-

-

-

-

Anc

illar

y se

rvic

esH

C.4

3.4

4.

7

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

M

edic

al g

oods

to o

ut-p

atie

nts

HC

.525

.8

23.2

-

-

32.2

-

-

-

38.9

-

-

-

Pha

rmac

eutic

als

HC

.5.1

22.2

22

.8

-

-

20

.7

-

-

-

24

.9

-

-

-

The

rape

utic

app

lianc

esH

C.5

.23.

7

0.4

-

-

11

.6

-

-

-

13

.9

-

-

-

Per

sona

l hea

lth c

are

serv

ices

an

d go

ods

HC

.1-H

C.5

96.2

95

.5

-

-

97

.9

85.1

-

85

.1

100.

0

100.

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

P

reve

ntio

n an

d pu

blic

hea

lthH

C.6

1.4

2.

0

-

-

-

-

-

-

-

-

-

-

Hea

lth a

dmin

. and

insu

ranc

eH

C.7

2.3

2.

4

-

-

2.1

14

.9

-

14.9

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

C

urr

ent

exp

end

itu

re o

n h

ealt

h c

are

100.

0

100.

0

-

-

100.

0

100.

0

-

100.

0

100.

0

100.

0

-

-


42

List of OECD Health Technical Papers on SHA-based Health Accounts OECD Health Technical Papers No. 1 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Australia

OECD Health Technical Papers No. 2 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Canada

OECD Health Technical Papers No. 3 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Denmark

OECD Health Technical Papers No. 4 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Germany

OECD Health Technical Papers No. 5 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Hungary

OECD Health Technical Papers No. 6 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Japan

OECD Health Technical Papers No. 7 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Korea

OECD Health Technical Papers No. 8 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Mexico

OECD Health Technical Papers No. 9 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies The Netherlands

OECD Health Technical Papers No. 10 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Poland

OECD Health Technical Papers No. 11 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Spain

OECD Health Technical Papers No. 12 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Switzerland

OECD Health Technical Papers No. 13 SHA-based Health Accounts in Thirteen OECD Countries: Country Studies Turkey

SHA-Based Health Accounts in 13 OECD Countries: … · SHA-BASED HEALTH ACCOUNTS IN THIRTEEN OECD...

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